Death Certificate - Witherspoon, Betty J_8/18/2017 LOCAL REGISTRAR 9LUra
/ ..:.. ".� S, MISSOURI DEPARTMENT OF HEALTH
ST LOUIS CO DEPT PUBLIC HEALTH '� """
4 s. AND SENIOR SERVICES
6121 N HANLEY RD
-16,.•_:.c '^; FEE RECEIPT
BERKELEY MO 63134
FILED ?° R` DEATH CERTIFICATION•F Y�J SJ s, OFYISSOVP\.
AUG 18.2017 REGISTRANT(S):
BOPP CHAPEL BETTY J WITHERS POON
10610 MANCHESTER `f)(-. D9999-999999
KIRKWOOD MO 63122 10 COPY
GIBSON COUNTY AUDITOR
YOUR RECENT REQUEST HAS BEEN ACTED UPON AS INDICATED BELOW: MO S80-0698(2.12)
DATE RECEIVED TOTAL AMOUNT AMOUNT THIS REQUEST PROCESSING FEE REFUND
REQUIRED
12/22/2016 103 . 00 13 . 00 0 . 00 0 . 00
UNAPPLIED REMITTANCES ONLY VALID FOR ONE YEAR AFTER RECEIPT.When you inquire about your request,
please return this receipt.If a refund is indicated,it will be mailed within 30 to 60 days.
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